Selective arterial embolisation in aneurysmal bone cysts

Summary The treatment of three cases of aneurysmal bone cyst by selective arterial embolism is described. Two cases had involvement of the pelvis and one of the knee. The 2-year follow up has been promising. Radiologically the lesion has been arrested with increased density of the cyst wall and intra-cystic trabecular new bone formation. Pain relief has been complete and up to now no surgical treatment has been required.

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Résumé Présentation de l'évolution clinique et radiologique de trois cas de kyste osseux anévrysmal, deux localisés au bassin et le troisième au genou, traités par embolisation artérielle sélective. Les résultats, avec 2 ans de recul, sont encourageants. Radiologiquement la lésion paraît stabilisée avec densification des parois et apparition de travées d'os nouveau à l'intérieur du kyste. Les douleurs ont complétement disparu et jusqu'à présent aucun geste chirurgical n'a été nécessaire.

     

Ventricular/paraventricular small arteriovenous malformations: role of embolisation with cyanoacrylate

Arteriovenous malformations (AVMs) located in or near to ventricles have proven difficult to treat. We report the safety and efficacy of embolisation of these deep central lesions and describe the contribution of embolisation to multimodality treatment. Fourteen consecutive patients with small (less than 3 cm) ventricular/paraventricular AVMs arranged for possible embolisation to their nidi. All patients presented with intracranial haemorrhage. The AVMs ranged in size from 10 to 30 mm (average, 17 mm). Embolisations were performed using liquid adhesive (cyanoacrylate and iodised oil mixture at a ratio of less than 1:4) delivered by flow-guided microcatheters with the patient under general anaesthesia. One patient (7.1%) was considered unsuitable for embolisation, and another (7.1%) was not able to undergo embolisation because of the morphological features of the AVM feeders, while the remaining 12 could be embolised successfully. Six of 12 patients who underwent embolisation achieved complete occlusion of their AVMs (overall occlusion rate, 42.9%), while the remaining 6 were embolised partially with a 60–95% (mean = 80%) size reduction. One (8%) permanent neurological deficit resulted from embolisation. Endovascular therapy seems to make a significant contribution to the multimodality treatment of small AVMs located in the ventricle or paraventricular deep area. Embolisation alone permits complete cure in a large number of patients. It results in obliteration of a significant volume of the nidus in most of the remaining patients, which makes those nidi more vulnerable to subsequent multimodal therapy.     

A traumatic intra-renal pseudo-aneurysm in a child

Intra-renal pseudo-aneurysms after penetrating renal trauma have not been reported in children. We report a case of a 9-year-old girl who presented with gross haematuria 2 weeks following renal exploration for a penetrating injury. The diagnosis of intra-renal pseudoaneurysm was made by Doppler ultrasound and was successfully treated by selective arterial embolisation.     

Haemobilia after penetrating and blunt liver injury: treatment with selective hepatic artery embolisation

Although traumatic haemobilia is uncommon and occurs in less than 3% of liver injuries, the magnitude of the bleeding may result in life-threatening complications. This study evaluated the efficacy of selective hepatic artery embolisation (HAE) in the control of bleeding in patients with traumatic haemobilia. The demographic, clinical and angiographic data on all patients with traumatic haemobilia were obtained from a prospectively documented database of patients undergoing visceral angiography for liver haemorrhage between 1967 and 2002. During the 36-year period under review, 30 patients were found to have haemobilia on selective hepatic angiography. Ten of these 30 patients had haemobilia due to accidental non-iatrogenic trauma and form the basis of this study. In 8 of the 10 patients haemobilia resulted from penetrating liver injuries and two patients had blunt trauma. The mean delay between the initial injury and the diagnosis of haemobilia was 23.5 (range 1-120) days. The mean blood loss before angiography was 8 (range 3-19) units. Six patients were treated successfully with selective hepatic arterial embolisation, three required surgery and one resolved without any intervention. There were no deaths and no complications resulting in long term sequelae. Traumatic haemobilia is an uncommon but life-threatening complication of liver injury. Selective arterial embolisation is the initial treatment of choice with a substantial rate of success and a low incidence of serious complications.     

Stellenwert der Magnetresonanztomographie für Indikationsstellung, Interventionsplanung und Nachsorge bei transarterieller Embolisationsbehandlung des Uterus myomatosus

ZusammenfassungZielsetzung Darstellung des Stellenwerts der Magnetresonanztomographie für die Indikationsstellung, Interventionsplanung und Nachsorge bei der transarteriellen Embolisationsbehandlung des symptomatischen Uterus myomatosus unter Berücksichtigung der aktuellen Literatur sowie eigener Ergebnisse.Material und Methodik Retrospektive Auswertung der MRT-Untersuchungen vor und nach Myomembolisation eines Kollektivs von 130 Patientinnen. Darlegung charakteristischer kernspintomographischer Bildbefunde und ihrer Bedeutung für die Indikationsstellung, Durchführung und Nachsorge. Einordnung der Ergebnisse in Zusammenschau mit der Literatur.Ergebnisse Die in der Literatur mitgeteilten mittelfristigen Ergebnisse zeigen eine Erfolgsrate des Verfahrens mit Verbesserung myombedingter Beschwerden in 82–94% und Größenreduktion der Myomknoten um durchschnittlich 36–64%. Typische Degenerationsformen von Leiomyomen des Uterus sowie das kernspintomographische Erscheinungsbild relevanter Differenzialdiagnosen werden exemplarisch dargestellt. Die für die Indikationsstellung relevanten Informationen zu Lage, Größe und Zahl der Myomknoten lassen sich kernspintomographisch sicher erheben. Eine Auswertung von 60 Patientinnen des Kollektivs zeigte in 16% der Fälle solitäre Leiomyome. In 47% der Fälle lagen 2–10 Myomknoten und in 37% mehr als 10 Leiomyome vor. Suberserös gestielte Leiomyome stellen eine Kontraindikation des Verfahrens dar und fanden sich in 5% der Fälle. Die MR-Angiographie erwies sich als vorteilhaft zur präinterventionellen Abklärung der pelvinen Gefäßanatomie und kann Kollateralen der Uterusversorgung nachweisen. Kontrastmittelunterstützte Aufnahmen eignen sich zur Kontrolle der erfolgreichen Devaskularisation nach Myomembolisation sowie zur Abklärung von Komplikationen.

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Uterine artery embolisation to treat severe haemorrhage following legal abortion

The aim of this paper is to present a case of hemorrhagic complication following a legal abortion treated with uterine embolisation. A 45-year-old woman, with a history of one caesarean section and seven legal induced abortions, requested legal induced abortion at 12 weeks of amenorrhea. Legal induced abortion was performed as a day case using vacuum aspiration with a plastic cannula under general anaesthesia. Severe haemorrhage, with an estimated blood loss of 800 ml, occurred during the procedure. Bleeding was not related to cervical laceration, incomplete abortion, or uterine perforation. Surgical conservative procedures and intravenous use of sulprostone (Nalador) failed to control haemorrhage. The patient underwent uterine artery embolisation with Curaspon, a porcine-derived gelfoam, used for the temporary occlusion of the visceral arteries. Successful hemostasis was obtained. The patient presented no complication related to the procedure. Severe haemorrhage following legal induced procedure is rarely reported. Emergency arterial embolisation may offer an effective modality of treatment.     

Embolization of vascular malformations

Often vascular malformations (VMs) can only be treated by multiple modalities. Alongside surgical interventions and laser therapy, embolization and sclerotherapy of such lesions have become mainstays of clinical management and sometimes represent the sole option for treating acute and life-threatening hemorrhages. In a total of 315 sessions, we embolized 133 patients with VMs of non-cerebral origin. Primary focus was placed on arteriovenous malformations (AVM). The outcome was classified as successful only when we were able to embolize the shunt level. For this purpose, liquid embolizing and sclerosing agents were applied alone or in combination with particle suspensions. Recurrence rates, especially for maxillofacial malformations, were dependent on disease spread, pretreatment status and patient age, and proved high overall. In practical terms, it was not possible to completely or permanently eliminate AVMs which had been long-standing or had received pretreatment by unsuitable methods. Embolization represents an indispensable part of every overall therapeutic concept for VM management. Acute hemorrhages are manageable in nearly all cases; in selected disease processes, a cure can be accomplished by embolization alone.     

Massive recurrent haemoptysis in a pregnant woman with preeclampsia

Massive haemoptysis are rare in pregnant woman. Besides usual causes of haemoptysis, cases of idiopathic haemoptysis have been described during pregnancy, probably with a hormonal role. A pregnant woman at 22 weeks amenorrhoea was admitted in intensive care unit for massive and recurrent haemoptysis, enhanced by bouts of hypertension in a context of preeclampsia. Arteriography showed bronchial hypervascularisation, with abnormally dilated bronchial arteries, and a lot of collateral arteries. Three sessions of bronchial artery embolization have been performed with success. The management of idiopathic haemoptysis in pregnant woman seems to be based on the usual algorithm of management, emphasizing on the control of blood pressure, and the key role of interventional radiology.